Predictors of Thirst in Intensive Care Unit Patients

Abstract

Context Thirst is a pervasive, intense, and distressing symptom in intensive care unit (ICU) patients. Although thirst may be avoided and/or treated, scant data are available to help providers identify patients most in need. Objectives This study was designed to identify predictors of the presence, intensity, and distress of thirst in ICU patients. Methods This descriptive cross-sectional study enrolled 353 patients from three ICUs (medical-surgical, cardiac, and neurological). To measure outcomes, patients were asked to report the presence of thirst (yes/no) and, if present, to rate its intensity and distress on zero to 10 numeric rating scales (10 = worst). Predictor variables were demographic (e.g., age), treatment-related (e.g., opioids), and biological (e.g., total body water). Data were analyzed with logistic regression and truncated regression with alpha preset at 0.05. Results Thirst presence was predicted by high opioid doses (≥50 mg), high furosemide doses (>60 mg), selective serotonin reuptake inhibitors, and low ionized calcium. Thirst intensity was predicted by patients not receiving oral fluid and having a gastrointestinal (GI) diagnosis. Thirst distress was predicted by mechanical ventilation, negative fluid balance, antihypertensive medications, and a GI or “other” diagnosis. Conclusion Thirst presence was predicted by selected medications (e.g., opioids). Thirst intensity and/or thirst distress were predicted by other treatments (e.g., mechanical ventilation) and medical diagnoses (e.g., GI). This is one of the first studies describing predictors of the multidimensional characteristics of thirst. Clinicians can use these data to target ICU patients whose thirst might warrant treatment.

Thirst in Patients with Heart Failure : Description of thirst dimensions and associated factors with thirst

“…Thirst has previously been measured and described in healthy persons, 27 in patients with renal failure, [28][29][30] terminal illness, 31,32 diabetes, 33,34 in critically ill patients at intensive care unit, 35,36 and in patients with HF. 11,20 Thirst has mostly been described in research with the sensation of intensity, 11,26,28,35,[37][38][39][40][41] which refers to the strength of the thirst.…”

“…11,20 Thirst has mostly been described in research with the sensation of intensity, 11,26,28,35,[37][38][39][40][41] which refers to the strength of the thirst. 37 Thirst has also been described using the measurement of distress, 8,9,26,35 which is to what degree the patient is bothered by thirst.…”

“…11,20 Thirst has mostly been described in research with the sensation of intensity, 11,26,28,35,[37][38][39][40][41] which refers to the strength of the thirst. 37 Thirst has also been described using the measurement of distress, 8,9,26,35 which is to what degree the patient is bothered by thirst. 37 Thirst can also be described as the frequency of thirst 35,37,42 and as the quality of thirst, 6,7,10,36 which is how thirst is described to feel like and its associated discomfort.…”

Research in Review: Driving Critical Care Practice Change

“…65 Two excellent review papers have recently been published on the multidimensional concept of thirst. 66,67 In a 2015 study by Stotts et al, 68 predictors of the presence, intensity, and distress of thirst in 353 ICU patients were described. Among these patients, the presence of thirst was higher for patients receiving opioids (≥ 50 mg opioid equivalents in 24 hours), furosemide (> 60 mg), and selective serotonin reuptake inhibitors.…”

“…Of note, only 17 patients were being treated with mechanical ventilation; thus additional research is needed in this population. The article by Stotts et al 68 is important because it delineates some of the factors that may aid in the identification of patients at increased risk for thirst.…”